Medications · Brain & nerves
Alzheimer's & Dementia Medicines Before Surgery
If you or someone you care for takes a dementia medicine, it's usually continued around surgery. Here's the one thing the anesthesia team needs to know — plus simple steps that lower confusion after the operation.
Quick answer
Why it matters
Donepezil, rivastigmine and galantamine work by raising a body chemical (acetylcholine). That same chemical is involved in how anesthetic muscle-relaxant drugs behave — these medicines can make one type (succinylcholine) last longer and make another type work less well. None of this is dangerous when the team knows; it just changes their choices.
These medicines can also slow the heart rate, so your anesthesiologist keeps an eye on it, especially with other drugs that do the same. Memantine works differently and is generally continued without these effects.
Most teams continue dementia medicines through surgery. Occasionally a surgeon or anesthesiologist may discuss pausing donepezil before a big operation where lots of muscle relaxant is expected — but that's their call to make with you, not something to do on your own.
The bigger challenge after surgery is often confusion or delirium, which is common in older adults and those with dementia. It's usually temporary. Having familiar faces, glasses and hearing aids, good pain control, sleep and hydration all genuinely help.
Do not stop without instruction
What to ask your doctor
- We take [name] for dementia — should it continue as normal, including the morning of surgery?
- Does this medicine change which muscle-relaxant drugs you'll use?
- What can we do to reduce confusion (delirium) after the operation?
- Can a family member or carer stay close in recovery, and can we bring glasses and hearing aids?
Red flags — call your team
Red flags — call your team
- New or worsening confusion, agitation, hallucinations or not recognising people after surgery — tell staff. It's often temporary delirium, but it needs reviewing (and checking for pain, infection or constipation).
- A very slow heart rate, faints or collapses — mention the cholinesterase-inhibitor medicine, as it can contribute.
References
- Alzheimer’s Society / Alzheimer’s Association — hospital stays, surgery and anaesthesia. alzheimers.org.uk
- BJA Education — anaesthesia and the patient with dementia; postoperative delirium. bjaed.org
- Reviews of cholinesterase inhibitors and neuromuscular blockade (PMC). ncbi.nlm.nih.gov
Frequently asked questions
Do dementia medicines need to be stopped before surgery?
Usually no — donepezil, rivastigmine, galantamine and memantine are generally continued. The key is telling the anesthesia team you take one, because the first three can change how certain muscle-relaxant drugs behave and can slow the heart. They'll plan around it.
Why does my anesthesiologist need to know about donepezil (Aricept)?
Donepezil and similar drugs raise acetylcholine, which affects how anesthetic muscle relaxants work — making one (succinylcholine) last longer and another work less well — and can slow the heart rate. Knowing this lets the team choose the right drugs and doses safely.
How can we reduce confusion after surgery in someone with dementia?
Post-op delirium is common and usually temporary. Familiar faces staying close, bringing glasses and hearing aids, good pain relief, keeping to a day-night routine, staying hydrated and avoiding constipation all help. Tell staff about the person's normal baseline so changes are spotted early.